Frequently Asked Questions
- What does being “attributed” to OneCare mean?
- Why did I get a letter from OneCare?
- Why did I become a part of OneCare?
- What if I didn’t get a letter from OneCare or don’t remember if I did?
- Is OneCare an insurance company?
- Is OneCare changing my insurance policy?
- Will being in OneCare cost me money?
- How does an ACO like OneCare benefit me?
- How do I know if my doctor works with OneCare?
- How do I know if I’m part of the ACO?
- What kind of health care information is shared with OneCare? What is claims data?
- What if I do not want OneCare to use my health care information?
- Beneficiary Rights and Responsibilities
- I need health insurance or have questions and concerns about my coverage—can OneCare help?
- What is OneCare?
- What is OneCare Vermont’s connection to the state of Vermont’s All-Payer Model (APM)?
- Why use an accountable care organization (ACO) to reform health care?
- Is supporting Medicare for All, Universal Primary Care, or a Single-Payer health care system in conflict with OneCare Vermont?
- How is OneCare changing health care?
- What results is OneCare seeing so far?
- How is OneCare governed?
- What is the overview of the OneCare budget?
- What is OneCare’s tax status?
- OneCare Vermont 990 Forms
- Financial Audits
- What if I have more questions or a suggestion for this page?
- Need help accessing health care and/or health care insurance? Find contact information here for: The Office of the Health Care Advocate, Medicaid, Medicare, Blue Cross Blue Shield of Vermont Commercial, MVP Health Care, and the Department of Vermont Health Access (DVHA).
Answers to FAQs
What does being “attributed” to OneCare mean?
Being attributed to OneCare means your health care provider is a member of the OneCare accountable care organization and you are part of a panel of their patients they are caring for in what is called a value-based care model. In a value-based care model, doctors can focus more on the right care needed to improve health outcomes and less on the volume of appointments, services, and tests run to support the business of health care.
Why did I get a letter from OneCare?
If you have been notified via a letter that you are part of OneCare, the bottom line is nothing changes for you as it doesn’t change your insurance or the providers you see.
The only difference is that the claims submitted to your insurance company for the health care services you receive (visits to the doctor, tests run, and treatments or surgeries performed) will be shared with OneCare toward efforts to improve quality of health care provided. Claims data includes billing and utilization information. Claims data does NOT include medical records, visit summaries, or other personal information.
Why did I become a part of OneCare?
Your doctor or health care provider is a part of OneCare, a statewide accountable care organization (ACO), and as their patient you have been “attributed” to OneCare. An ACO is a group of doctors, hospitals, and other health care providers who work together to provide high quality care and lower costs.
What if I didn’t get a letter from OneCare or don’t remember if I did?
If you didn’t get a letter, this means you aren’t part of the portion of patients at your providers office that were attributed to OneCare. Your provider may not be contracting via OneCare with your insurance provider. If you are unsure if you received a letter and want to confirm if you are attributed to OneCare, see “How do I know if I’m part of the OneCare ACO?”
Is OneCare an insurance company?
No. OneCare is an accountable care organization. OneCare contracts with Medicaid, Medicare, and some commercial health insurance companies, like MVP, to contract on behalf of the over 5,000 providers who are members of the OneCare accountable care organization. This is an efficient way to deliver fixed payments to providers so they can worry less about the business of health care (the billable appointments, services, and tests) and focus more on the care of health care.
Is OneCare changing my insurance policy?
No. Your insurance will stay the same. OneCare does not change your health insurance coverage. If your doctor is a member of OneCare, your health benefits and which providers you can see will not change in any way. You can continue to see any doctor, hospital, or other health care provider you choose, as allowed by your health plan. Being a part of OneCare does not change your provider or your provider’s location.
Will being in OneCare cost me money?
No. Being part of the ACO is completely free to patients. OneCare and your insurance company pay your provider for health services you receive. You will never receive a bill from OneCare.
How does an ACO like OneCare benefit me?
OneCare makes it easier for your health care providers to share information and work together to improve the quality of care and the overall health outcomes of patients. OneCare makes prevention a priority to keep you healthy by requiring certain measures that are proven to improve quality of care—catching disease early and considering social contributors of health (food, housing, and transportation access, systemic racism, etc) as part of diagnosis and treatment plans. OneCare rewards your health care providers when they give you high quality health care. To do this, some of your health care information will be shared with OneCare via claims data. You can rest assured that your data is protected in compliance with strict requirements from the federal government and our deep commitment to data protection laws. Learn what “claims data” is here.
How do I know if my doctor works with OneCare?
You have a few options.
View our participant network list – hospitals, organizations, and collaborators that work with OneCare:
Call 802-847-7220 or toll free at 1-877-644-7176.
You can also ask your provider’s office directly.
Note that even if your doctor is participating in the OneCare Vermont accountable care organization, not all of their patients will be “attributed” to OneCare at this point in time.
How do I know if I'm part of the ACO?
If you are part of the OneCare ACO, you will receive a member notification letter from OneCare or from your insurance company. This letter contains information about how OneCare works, as well as how to opt out of sharing information with OneCare. If you haven’t received a letter, you are not part of the OneCare ACO. If you have received a letter and have questions about the notification letter that can’t be answered here, please contact us.
What if I do not want OneCare to use my health care information?
OneCare makes it easier for your doctors and other health care providers to share information and work together to give you the best possible care. If you do not want your health insurance carrier to share your claims data with OneCare by opting out of data sharing, please follow the instructions in your letter from OneCare or contact us at 1-877-644-7176 or firstname.lastname@example.org. Your privacy is very important to us.
Beneficiary Rights and Responsibilities
OneCare and its network fully supports and complies with all applicable state and federal laws regarding member rights.
I need health insurance or have questions and concerns about my coverage—can OneCare help?
OneCare is not a health insurance company or a health care provider. We work with providers, organizations, and with payers like Medicaid, Medicare, and commercial insurers to transform the state’s health care system from “fee-for-service” to “value-based care.”
For help with a health issue: contact your provider or the Vermont Health Care Advocate at the contact information provided at the bottom of this page.
If you are experiencing a health care emergency, please call 911. Information about calling 911: https://www.911.gov/calling-911/
For assistance with your health care insurance, please get in touch with your insurance provider – contact information for Medicaid, Medicare, BCBSVT, and MVP is further down on this page.
What is OneCare?
OneCare is Vermont’s local, 501(c)(3) accountable care organization (ACO), partnering with health care providers to transform the state’s health care system from “fee-for-service” to “value-based care.” ACOs were born out of the Affordable Care Act and as Clif Gaus of the National Association of Accountable Care Organizations puts it in the book The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, “‘If I say one thing about ACOs, it’s a long fix.'”(Lee, 2020, p. 196). Pivoting our health care system to one that pays for improved health outcomes instead of for the quantity of services is a Herculean effort. And yet, ACOs are working across the country to make this shift. What is unique about the OneCare ACO is that we are working to support the State of Vermont’s All-Payer Model which means we don’t only contract with Medicaid and/or Medicare as is the case in most all other states. We also contract on behalf of the over 5,000 of Vermont’s providers who are members of OneCare with commercial insurers engaged in shifting to a value-based care system—also known as pay-for-value or pay-for-results. The OneCare ACO makes it possible to more efficiently spread value-based care throughout our state.
Watch Video: OneCare Vermont: Reducing Health Care Spending and Improving Health Outcomes on Vimeo
What is OneCare Vermont's connection to the state of Vermont's All-Payer Model (APM)?
Managed by the Vermont Agency of Human Services with the Green Mountain Care Board as the regulator, the All-Payer Model (APM) is a five-year (Jan 1, 2018-Dec 31, 2022) agreement between the governor’s office of Vermont and the federal government’s Centers for Medicare and Medicaid Services–currently extended two additional years to allow time to negotiate the next five-year agreement. The agreement allows Medicare—by waiving certain federal provisions to participate in alternative payment models—along with the Vermont Medicaid program and Vermont commercial insurers to pay for health care in a different way. OneCare Vermont contracts with providers, as well as the specific payer programs, to help achieve the goals of the All-Payer Model Agreement. Currently OneCare Vermont is the only ACO operating in Vermont that works with Medicare, Medicaid, and commercial insurers. State law and the APM does not preclude more than one ACO to operate in the state if they meet certain criteria. There is currently one Medicare-only ACO operating in Vermont called Lore Health.
Why use an accountable care organization (ACO) to reform health care?
Given the high cost of health care our nation is grappling with—coupled with poor health outcomes—many can agree there is a need to reform healthcare. Under the Affordable Care Act, ACOs are one type of an alternative payment model that can be used to reform the healthcare system and one that allows providers to work together under a shared quality and economic framework without running afoul of anti-trust law. OneCare is the entity that provides the necessary legal protections to the providers so that they come together in a unified way to be accountable for the care delivered to Vermonters.
Is supporting Medicare for All, Universal Primary Care, or a single-payer health care system in conflict with OneCare Vermont?
No. The work OneCare Vermont is doing to shift away from a fee-for-service model to a value-based model is work that needs to happen regardless of the federal or state structure of our healthcare system. In fact, Medicare for All, Universal Primary Care, and Single-Payer would benefit from a value-based system that provides fixed payments to care for a population rather than charging for every pill, test, or service.
How is OneCare changing health care?
OneCare Vermont is bringing value-based care to Vermont—changing the way we pay for and deliver care in order to reduce costs and improve the quality of care. The OneCare Vermont model first gets providers into a value-based care model through the contracts OneCare negotiates on behalf of its member providers. There are currently over 5,000 providers who are members of OneCare Vermont and OneCare negotiates contracts on their behalf with Medicaid, Medicare, and commercial insurers.
Once those contracts are in place, it is then OneCare’s job to help providers succeed. OneCare does this through its innovative payment reform model’s predictable payments; and through data-informed support of measures proven to increase quality of care and of a coordinated care model.
What results is OneCare seeing so far?
As an accountable care organization, OneCare is accountable for both the quality and cost of health care. Each year, health care organizations and providers in OneCare work together to meet quality measures and to achieve shared savings. Organizations participating in OneCare may earn financial incentives for meeting or exceeding quality benchmarks. Recent key accomplishments include:
- Significant health care savings: According to rigorous federal evaluations, OneCare has realized significant health care savings, with over nearly $60 million in shared savings paid to providers between 2018 and 2021.
- Lower costs: Vermont has been able to reduce high-cost services such as inpatient and emergency room visits as well as overall Medicaid cost growth. OneCare achieved Medicare gross spending reductions in all years it was evaluated by the federal government.
- Stabilized access to primary care: Due to the predictable monthly funding from OneCare, Vermonters have maintained access to primary care, the heart of a better model for care delivery.
- High quality: OneCare’s providers have consistently scored above average on quality of care. For example, in 2021, OneCare providers scored in the 90th percentile nationally for diabetes management.
- Stakeholder support: OneCare provides an important, unifying forum for providers, payers, and the state to engage in meaningful discussions about healthcare reform and set goals. The model is also strengthening relationships among a variety of providers, which has proven to be critical during the pandemic.OneCare is committed to supporting providers as they work to reach quality targets and achieve shared savings. Read more about our results, quality work plan, and shared savings on our results page.
OneCare is committed to supporting providers as they work to reach quality targets and achieve shared savings. Read more about our results, quality work plan, and shared savings on our results page.
How is OneCare governed?
OneCare is governed by a board of managers that makes key financial and operational decisions. Our board is made up of providers from throughout the state and continuum of care, as well as consumers. The list of our current board members can be viewed on the OneCare governance page. Each board meeting has a session open to the public. Meeting minutes and packets are available on each passed board meeting event page here.
What is the overview of the OneCare budget?
OneCare’s 2023 budget was provisionally approved by the Green Mountain Care Board (GMCB) in December 2022. The 2023 budget supports the cooperative effort of thousands of providers across Vermont to stabilize health care costs and improve health for Vermonters. To be successful in improving patient experiences and outcomes in 2023, the approved budget makes possible OneCare’s continued support of participating providers in areas such as: data management, monitoring quality, managing and mitigating risk, and working with payers like Medicaid, Medicare, and commercial insurers. Download and view our full 2023 budget presentation on the GMCB website.
What is OneCare's tax status?
OneCare Vermont has always operated as a non-profit in that it budgets to break even each year, however, as a provider-led accountable care organization (ACO) it is required to follow federal ACO program rules which state that 75% of its board include provider representatives whose organizations can receive savings and funding from the ACO. This requirement makes OneCare ineligible for Vermont non-profit status because Vermont law does not allow non-profits to have more than 49% of its board to have a financial interest. In October 2020, OneCare applied to the IRS for federal 501(c)(3) tax status to more accurately reflect our commitment to transparency and value-based reform efforts.
On April 22, 2021, OneCare received notification that it is recognized by the federal government as a 501(c)(3) organization for its commitment to supporting Vermont’s health care delivery and payment reform efforts. This is validation that the federal government believes OneCare meets the charitable purposes of a 501(c)(3) by lessening the government’s burden of health care through its partnership in the state of Vermont’s All Payer Model, and by the promotion of health in transition to value-based care, improved supports for primary care delivery, health care innovation, and primary prevention programs.
OneCare Vermont 990 Forms
PricewaterhouseCoopers (PwC) audits OneCare’s financials and has given OneCare Vermont a clean audit report for 2017, 2018, 2019, and 2020. Use the links below to access financial audits for OneCare Vermont.
Health Care Access & Insurance Resources
The Office of the Health Care Advocate
The Office of the Health Care Advocate (HCA) is a free resource for Vermonters regarding all aspects of health care. The HCA gives free advice and help to all Vermonters with health care and health insurance concerns. The HCA is part of Vermont Legal Aid, an independent non-profit law firm. The HCA does not represent OneCare Vermont. To get help with a health care or health insurance issue, call the HCA Helpline toll free 1-800-917-7787 to speak to a health care advocate, or visit their website here.
Insurance Payer Contact Information
Call Medicare at: 1-800-MEDICARE (1-800-663-4227)
For the Medicare & You Handbook, click here.
MVP Health Care
Customer/Member Services: 1-800-825-5687 (general comments, questions and information) or click here.